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Annual Wal kthrough Checklist (Contractor) <br />Does not replace ES -37 <br />iD# 953 ANNUAL DISPENBER CHECKLIST <br />Dat.: 06/30/2025 <br />Category Description <br />PEURP906 WA Disp i Disp 2 lisp 3 Oisp 4 <br />Initial Fuel Dispenser Inspectim <br />8.5 <br />ul I}ispensers <br />All drsr corr>ri� poare clean and dry <br />perre <br />€.5.1 <br />❑ Yes <br />Yes <br />Yes <br />Yes <br />if dispenser sump is presem surnp is dry 8.5.2 ❑ Yes Yes Yes <br />Yes <br />Fuel Dispenser Inspection <br />8.6 <br />❑ Yes <br />Yes <br />Yes <br />Yes <br />Visible piping and fittings show no signs of leaking <br />8.6.1 <br />❑ Yes <br />Yes <br />Yes <br />Yes <br />Piping m good conddrorr <br />8.a.z <br />❑ Yes <br />Yes <br />Yes <br />Yes <br />fi:l as sets <br />Diss s r containment surnp free of t^ h and debris <br />8-6-5 <br />❑ Yes <br />Yes <br />Yes <br />Yes <br />Artywatet or product removed and disposed o►properly <br />8.6.4' <br />❑ Yes <br />Yes <br />Yes <br />Yes <br />Dispensers YYdh <br />Sump free of cracks, holes. bulges, or other defem <br />MAL <br />❑ Yes <br />Yes <br />Yes <br />Yes <br />Penetnatianfittings pct and secured 897 ❑ Yes Yes Yes <br />Yes <br />Piping iniersRol spatia open to the dispenser sump or dispenser pan {open double -walled piping system onlyj <br />$ $ 21 <br />Piprlg nterstitis- space c used to the disperser sump {closeddouble-walled piping systaru ontp) <br />3.6.22 <br />❑ Yes <br />Yes <br />Yes <br />Yes <br />Category <br />Oescriptinn <br />PEI+RPSDG WA "sp 5 <br />Disp 6 <br />Disp 7 <br />Disp E <br />Imb3l Fuel Dispenser Inspection <br />9.5 <br />KI O:spanse;s Ali c sce-ser cc^-oonents are clear and dry <br />S.F., <br />❑ Yes <br />Yes <br />Yes <br />Yes <br />if dispenser sumG = present, sump is dry <br />8.52 <br />❑ Yes <br />Yes <br />Yes <br />Yes <br />Fuel Dispenser Inspection <br />8l9 <br />Visible piping artd fittings showno signs of leaking <br />8.6.1 <br />❑ Yes <br />Yes <br />Yes <br />Yes <br />Piping w good conddwn 8.6.2 ❑ Yes Yes Yes <br />Yes <br />Ap Dispense <br />Drpenser containment sumpfF of trash and debns <br />3.8.5 <br />❑ Yes <br />Yes <br />Yes <br />Yes <br />Any wa!Er or product removed and disposed o€prnpeny <br />8.6A <br />❑ Yes <br />Yes <br />Yes <br />Yes <br />Dispensers With <br />Surnps <br />Sumo f-ee of cracx=_ holes. hulges. or other defect <br />-- <br />Pene:rs: c- - :: •;s -.:sc: 3rd secured <br />8.6.8 <br />❑ Yes <br />Yes <br />Yes <br />Yes <br />Yes <br />Yes <br />Yes <br />Yes <br />scaceopen tothe dispenser stw,)pordispenser pan (open doul>h-walled piping system only) <br />8d21 <br />Piping irrterstitial space dosed to the dispenser sump {closed double: walled piping sysierr, only) <br />8.6.22 <br />❑ Yes <br />Yes <br />Yes <br />Yes <br />OESCRI9E ANY DERCIENCIES HERE- <br />aaa¢tea trortt Ntl ltP y:K a �r 4 <br />